| NPI | 1376504530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME120282) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q2644) |
| 207P00000X Emergency Medicine (Licence: VA 0101050336) | |
| 207P00000X Emergency Medicine (Licence: MN 43376) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2018-03-17 |